Mental disorders among children and adolescents in Norway

We estimate that about 70,000 children and adolescents have mental disorders that require treatment. Psychological problems and mental disorders can lead to failure to thrive, learning disabilities and functional problems at home and school.

Published
14.10.2016

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Mental disorders are a major health problem in children and adolescents in Norway today. At any time, we estimate that 15-20 percent of children between three and 18 years have reduced function due to symptoms of mental disorders such as anxiety, depression and behaviour disorders (1-4). Of these, approximately half (8 percent) - about 70,000 children – will have such severe symptoms that meet the requirements for a psychiatric diagnosis. Most of these need treatment (1).

Incidence increases with age

Several of the mental disorders only become apparent after puberty, contributing to the rising incidence with age. Boys and girls often have different types of mental disorders, and children have other types of symptoms than adolescents.

Different incidence in boys and girls

Until six years of age, the incidence of mental disorders is about the same in girls as in boys, but this changes by the age of six. From six to 12 years, boys account for two-thirds of those who qualify for a psychiatric diagnosis. Concentration difficulties, ADHD and behaviour disorders are the most common disorders.

After 12 years of age, two out three with mental disorders are girls. They struggle primarily with anxiety and depression (4). The gender differences correspond with the population receiving treatment from the health services. Two out of three who receive psychiatric treatment under 12 years of age are boys. After 12 years, two out three are girls.

Normal to have transient symptoms

It is not unusual to have a mental disorder at some time during childhood. Surveys show that more than every third 16-year-old has at some stage had enough symptoms to meet criteria for a psychiatric diagnosis such as an anxiety, depressive or behaviour disorder (5). Norwegian studies indicate that 15-20 percent of young people have significant symptoms of depression (Table 1), and that up to five percent have such severe depressive symptoms that they have a diagnosable depressive disorder (point prevalence) (4, 6). In most cases, however, the symptoms are temporary. Many will barely satisfy the requirements for a diagnosis for a limited period.

Table 1. Self-reported symptoms of depression in young people aged 12-17 years, percentage

Response

Rarely

Sometimes

Often

Age *, years:

12–13

14–15

16–17

12–13

14–15

16–17

12–13

14–15

16–17

Depression symptoms

Is sad or unhappy

58

55

43

32

36

38

10

9

19

Is very restless

54

49

49

37

42

35

9

9

16

Is unhappy about something

86

77

73

12

21

19

2

2

8

Feels very little self-worth

81

76

76

14

19

16

5

5

8

Cries a lot

84

81

76

12

14

15

4

5

9

Feels lonely

78

74

64

18

20

26

4

6

10

* Number of respondents at 12-13 years of age : n = 523, at 14-15 years: n = 437, and at 16-17 years: n = 372 Source: TOPP study

For some, however, the symptoms are lasting, and the risk for this increases with age. Only a quarter of those with substantial symptoms at 18 months old will still have this at four years of age. However, as many as 40 percent of those who have a diagnosable mental disorder at four years old, will continue to have it at the age of 12 (8).

The sum of stresses and support

Mental disorders develop in a complex interaction between biological conditions, stress and available support. A large proportion of the symptoms seen in early adolescence is related to development conditions at a pre-school age (7).

The risk that a child will develop mental disorders increases in periods when the parents themselves have an increased symptom level (9, 10), conflict-filled relationship or lacking parenting skills. The risk also increases if the family has substantial stress or negative life events and little social support (7, 11), especially if the child also has a temperament characterized by high levels of shyness and negative emotions (12). It is the interaction between risk and protective factors that determine whether a child develops symptoms of mental disorders.

Most come from stable families

Most children who develop mental health problems come from ordinary families where there are generally few risk factors. However, it is normal for families to have stress and symptoms of mental disorders from time to time. This makes it difficult to predict which children will have problems later in life. We know however that the risk increases significantly when the strain that the child is exposed to, grows, affects other areas in life or lasts a long time.

Children and adolescents are most at risk of developing mental disorders in families where the parents have lasting mental disorders, are drug addicts or violent, or where the family or the children themselves have arrived as refugees with traumatic experiences of war, torture, violence and loss of family and friends (13). There is also high risk if the child is shunned by friends, is socially isolated, poorly integrated into the neighbourhood or bullied at school.

Children born with a biological vulnerability because the mother has used alcohol, illicit drugs, medications and / or tobacco, or have been malnourished or exposed to environmental toxins during pregnancy are particularly vulnerable to negative impact from difficult childhood circumstances It is nevertheless important to note that, overall, most children with symptoms of mental health disorders come from stable and well-functioning families where there are usually few lasting risk factors that dominate.

Important with early prevention

Today’s methods can help to find children who have symptoms. However, it is not possible in advance to separate those who will have temporary difficulties from those with chronic problems. There are many indications that it is easier to prevent mental disorders in children and adolescents when action is taken in early childhood - before the symptoms become chronic. This means that we must help children and young people who have already developed symptoms. In addition, we should improve the developmental environment of pre-school children who grow up with many and lasting burdens loads before they show symptoms.

Reports

Much of the content in this chapter is based on the Norwegian Institute of Public Health report (2): Psykiske lidelser i Norge: Et folkehelseperspektiv , rapport 2009:8.